同步悬空俯卧位对稳定期慢性阻塞性肺疾病患者膈肌功能影响的探讨  

Explore the simultaneous suspended abdomen prone position on respiratory function in patients with stable chronic obstructive pulmonary disease

作　　者：徐远达[1] 黎锐发[1] 罗远明[1] 许继平[2] 李宪玉[3] 

机构地区：[1]呼吸病国家重点实验室广州医学院,510120 [2]北京工商大学信息工程学院,100037 [3]北京航空医学研究所,100036

出　　处：《国际呼吸杂志》2010年第17期1025-1028,共4页International Journal of Respiration

基　　金：广东省科技攻关项目（20078031507010）

摘　　要：目的探讨同步悬空俯卧位对稳定期慢性阻塞性肺疾病（chronic obstractive pulmonary disease，COPD）患者膈肌功能情况的影响。方法5例稳定期COPD患者，在“人工呼吸床”上随机四种不同体位：①仰卧位；②悬空俯卧位；③托平俯卧位；④同步悬空俯卧位。每个体位观察10min，通过呼吸功能检测电极监测膈肌肌电、食道压和胃压等指标。结果四种体位对心率、氧饱和度、呼气末二氧化碳无明显的影响（P〉0．05），其中同步悬空俯卧的呼吸频率在四种体位中是最慢的（16±2．7）次／min，由慢至快呈现：同步悬空俯卧→仰卧→托平俯卧→悬空俯卧的趋势；同步悬空俯卧位的潮气量在四种体位中是最大的（600．7±122．5）ml；同步悬空俯卧位的跨膈压是（14．6±2．6）cmH2O，是四种体位中最小的，与托平俯卧位（22．6±2．5）cmH2O比较差异有统计学意义（P〈0．05），同步悬空俯卧位的膈肌肌电是（76．4±38．9）μV，是四种体位中最高的，但与其他体位比较差异无统计学意义（P〉0．05）。结论“人工呼吸床”上同步悬空俯卧位与其他两种俯卧呼吸体位一样，对COPD患者经短时间观察是安全稳定的；同步悬空俯卧位以最低的跨膈压，不但降低患者的呼吸频率，增加潮气量，在不增加呼吸做功的情况下，改善膈肌的运动能力。Objective Explore the simultaneous suspended abdomen prone position on respiratory function in patients with stable chronic obstructive pulmonary disease（COPD）. Methods Five cases of stable COPD patients,in the ＂artificial respiration bed＂ on a random one of four different positions, ① supine position. ②suspended abdomen prone position. ③fiat prone position. ④Synchronization suspended abdomen prone position. Each position observed for 10 minutes. Through the respiratory function test electrodes to monitor esophageal pressure and EMG,and gastric pressure. Results Four positions have no obvious effect to patient＇ s heart rate, oxygen saturation, end-tidal CO2 （ P 〉 0.05 ）, particularly, Synchronization suspended abdomen prone position demonstrates the lowest breathing rate（ 16± 2.7）/ min. In the process of the breathing rate from slow to fast of the four positions depicts a gradual change： Synchronization suspended abdomen prone position→supine position→ flat prone position→suspended abdomen prone position, Synchronization suspended abdomen prone position reaches the highest tidal volume（600.7± 122.5）ml, Synchronous suspended prone position of the transdiaphragmatic pressure （Pdi） is the smallest（14.6±2.6） cm H2O of the four position. There was significantly different compared with the flat prone position （22.6 ± 2.5） cmH2O （ P 〈 0.05）. Synchronous suspended prone position of the EMG is the highest （76.4 ± 38.9） μV, but there was no significant difference with the other position （ P 〉 0.05）. Conclusions Synchronization suspended abdomen prone position is secure to stable COPD patients compared to other prone position. With the lowest trans-diaphragmatic pressure, the subjects have significantly improved tidal volume and lower the breath rates. Without increasing work of breaths. Improved the exercise capacity of diaphragm.

关 键 词：俯卧位 慢性阻塞性肺疾病 潮气量 吸气相跨瞩肌压 膈肌肌电 

分 类 号：R563.9[医药卫生—呼吸系统]